New Study Examines Healthcare Provider Understanding of Different Health Risks Associated with Alternative Tobacco and Nicotine-Containing Products

June 8, 2026

Every year, millions of adult smokers turn to healthcare providers for advice on quitting. But what if the information providers are using is incomplete or outdated? A new study published in Internal and Emergency Medicine suggests exactly that, revealing gaps in clinicians’ understanding of the relative risks associated with cigarettes and alternative tobacco and nicotine[1] products.  

THE RESEARCH

The publication, “U.S. Healthcare Provider Risk Perceptions of Tobacco and Nicotine-Containing Products,” from Susan Martelle of RAI Services Company, Deena Battista of Womble Bond Dickinson, and Michael Polster of NAXION, conducted an online survey of 700 HCPs including physicians, nurses practitioners and physician assistants. The goal: uncover how well HCPs understand the health risks of cigarettes compared with non-combustible alternative products, and whether they believe switching may reduce harm.

The survey examined:

  • HCP awareness that combustion, not nicotine, is the primary source of risk from smoking cigarettes.
  • How HCPs perceive the risks of non-combustible alternatives such as e-cigarettes and nicotine pouches.
  • Whether HCPs believe switching completely from cigarettes to smoke-free products may reduce health risks.

WHAT THE RESEARCH SHOWS

The results paint a clear picture: many HCPs lack accurate, up‑to‑date information about what truly drives smoking-related harm.

  • On average, healthcare providers attributed only about 38% of the lung cancer risk from smoking cigarettes to smoke from burning tobacco, even though combustion is widely recognized as the primary source of cancer‑causing chemicals in smoking. This contrasts with statements from public health authorities, including former FDA Commissioner Scott Gottlieb, who have emphasized that combustible tobacco is the main driver of smoking‑related disease and death[2].
  • By comparison, healthcare providers attributed roughly 21% of lung cancer risk to nicotine, even though evidence summarized in the 2014 U.S. Surgeon General’s Report indicates that nicotine itself does not cause cancer. This pattern reflects a common overestimation of nicotine’s role relative to the harms caused by smoke[3].
  • Half of HCPs do not believe that switching completely from cigarettes to alternative smokeless tobacco and nicotine products may reduce health risks.
  • More than 60% of HCPs either never received smoking cessation training or received training more than 5 years ago.

THE TAKEAWAY

Healthcare providers play a critical role in providing evidence-based health and wellbeing guidance for their patients. For patients who smoke cigarettes, this survey highlights that these providers may not have the most current or accurate information regarding the potential benefits of encouraging adult smokers uninterested in quitting tobacco and nicotine products altogether of switching to non-combustible, smokeless product alternatives. Although nicotine is addictive and no tobacco product is without risk, this study adds to a growing body of research showing adult nicotine product knowledge gaps across the U.S. healthcare system. The message is clear – improving healthcare provider education on the continuum of risk across tobacco and nicotine products could directly improve the guidance patients receive and ultimately, help more adults quit smoking.

[1] Nicotine is addictive and no tobacco product is safe or risk-free.

[2] Gottlieb, S. (2017, June 28). Protecting American Families: Comprehensive Approach to Nicotine and Tobacco. U.S. Food and Drug Administration. https://www.fda.gov/news-events/speeches-fda-officials/protecting-american-families-comprehensive-approach-nicotine-and-tobacco-06282017

[3] U.S. Department of Health and Human Services. (2014). The Health Consequences of Smoking—50 Years of Progress: A Report of the Surgeon General. Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health.